EP0961628B1 - Catheter de dialyse presentant des lumieres rigides et souples - Google Patents

Catheter de dialyse presentant des lumieres rigides et souples Download PDF

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Publication number
EP0961628B1
EP0961628B1 EP97948217A EP97948217A EP0961628B1 EP 0961628 B1 EP0961628 B1 EP 0961628B1 EP 97948217 A EP97948217 A EP 97948217A EP 97948217 A EP97948217 A EP 97948217A EP 0961628 B1 EP0961628 B1 EP 0961628B1
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EP
European Patent Office
Prior art keywords
tube
lumen
blood vessel
patient
blood
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EP97948217A
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German (de)
English (en)
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EP0961628A1 (fr
EP0961628A4 (fr
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Aubrey M. Palestrant
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A61M25/003—Multi-lumen catheters with stationary elements characterized by features relating to least one lumen located at the distal part of the catheter, e.g. filters, plugs or valves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M2025/0025—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter having a collapsible lumen
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A61M25/003—Multi-lumen catheters with stationary elements characterized by features relating to least one lumen located at the distal part of the catheter, e.g. filters, plugs or valves
    • A61M2025/0031—Multi-lumen catheters with stationary elements characterized by features relating to least one lumen located at the distal part of the catheter, e.g. filters, plugs or valves characterized by lumina for withdrawing or delivering, i.e. used for extracorporeal circuit treatment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A61M2025/0034—Multi-lumen catheters with stationary elements characterized by elements which are assembled, connected or fused, e.g. splittable tubes, outer sheaths creating lumina or separate cores
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A61M2025/0037—Multi-lumen catheters with stationary elements characterized by lumina being arranged side-by-side
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter

Definitions

  • the present invention relates generally to multi-lumen catheters inserted into the vascular system for extended periods of tie, and more particularly, to a semi-collapsible dialysis catheter inserted into the venous system of humans and animals.
  • Placement of large, multi-lumen catheters into humans and animals for various purposes is a commonly performed procedure.
  • dual-lumen catheters are often placed into the venous system to perform hemodialysis for patients suffering kidney failure.
  • Hemodialysis catheters are designed to accommodate substantial blood flow rates, and are therefore relatively large, often measuring greater than 13 French in size.
  • the cross-sectional profile of such catheters typically have either a twin-circular, "figure-eight" configuration joined at one point, or a so-called double-D configuration.
  • the lumens of the blood inlet and blood outflow channels are both equal in size, thereby balancing the blood removal flow rate with the blood return flow rate.
  • the necessity to make both lumens equal in size creates an overall catheter of relatively large cross-sectional dimensions.
  • Such large profile catheters can cause complications when left in the venous system.
  • Placement of a catheter within a blood vessel necessarily creates turbulence, and a slowing of blood flow, within the blood vessel.
  • the catheter is a foreign body, and the surface of the catheter in contact with blood acts as a nidus for clot formation.
  • a further problem with the existing dual-lumen catheters is that blood may remain in the catheter during rest periods when the catheter is not being used to perform dialysis; blood collected within the lumens may form a clot, obstructing the passage of fluids through the catheter, thereby rendering the catheter unusable. Should this occur, the catheter may need to be removed and replaced with a new one. This procedure poses an inconvenience and a burden to both the patient and the attending physician, and adds to the cost of maintaining venous access for dialysis.
  • WO 97/37718 discloses a dual-lumen catheter.
  • U.S. Patent No. 5,106,368 to Uldall et al. discloses a dual-lumen catheter for vascular access. This document is regarded as closest prior art.
  • the distal portion of the catheter includes two tubular members attached to each other, one of which is formed by a thinner wall to make such tubular member collapsible.
  • the collapsible lumen is temporarily held in its collapsed state by a peel-away sheath for insertion into the blood vessel. Once the catheter is in position, the sheath is removed and the collapsed tubular member regains its circular configuration.
  • Uldall et al. do not reduce the cross-sectional area or surface area of the catheter once it is placed in the vein.
  • U.S. Patent No. 4,406,656 issued to Hattler, et al. discloses a multi-lumen catheter adapted to be inserted through the center of an insertion needle into the vein of a patient.
  • the catheter disclosed by Hattler et al. includes two or more collapsible, elastic peripheral lumens formed around a flexible, but non-collapsible, central lumen.
  • the peripheral lumens stretch to accommodate increasing flow and, therefore, a greater pressure must be applied to the infused fluid in order to adequately stretch the lumen to open it.
  • the need to generate such additional pressure to fully inflate one or more peripheral lumens is a disadvantage, since the equipment being used to infuse fluids into the blood vessel must then be capable of generating such greater pressures.
  • Hattler et al. teaches persons skilled in the art to extend the collapsible, peripheral lumens through the entry point of the patient's skin and vein.
  • Hattler et al. state that the patient's skin is resilient enough to accommodate the expansion of the collapsed lumens during fluid flow without tearing the skin.
  • the degree of expansion of a collapsed lumen is great enough to effectively increase the size of the puncture at the skin entry site and the vein, posing the risk of tearing, bleeding, and infection.
  • Still another object of the present invention is to provide such a catheter which minimizes the surface area of the catheter exposed to the blood when infusion or dialysis procedures are not being performed.
  • a further object of the present invention is to provide such a catheter which minimizes the likelihood of blood entering, or collecting within, an infusion lumen of the catheter and forming a blockage therein.
  • the catheter of the present invention is useful in a method for gaining access to a blood vessel to perform chronic dialysis while minimizing the risks of creating blood clots around or within the catheter.
  • Still another object of the present invention is to provide such a catheter which maintains a relatively constant catheter tract size through the skin entry point and blood vessel wall whether fluid is being infused or not being infused.
  • the first ends of both the first and second lumens are adapted to extend within the blood vessel of the patient generally proximate to one another, while the second ends of the first and second lumens remain outside the patient's body for exchanging fluids with the blood vessel of the patient.
  • the second end of the second lumen which is disposed outside the patient's body, is sufficiently rigid to maintain a generally-cylindrical shape in the absence of any positive fluid pressure applied to the second end of the second lumen.
  • the second lumen includes a transition region which separates the collapsible first end thereof from the remaining non-collapsible portion of the second lumen; following insertion of the catheter, the transition region extends within the blood vessel of the patient.
  • the catheter may include first and second connector tubes, as well as a connector hub.
  • the connector hub is secured to the second ends of the first and second lumens and couples the second ends of the first and second lumens to respective ones of the connector tubes.
  • the catheter of the present invention can be inserted into a blood vessel using an introducer sheath, with or without the aid of a guide wire.
  • the introducer sheath which is preferably of the "peel-away" type, extends through the patient's skin and into the patient's blood vessel, and the first ends of the first and second lumens are inserted into and through the introducer sheath for placement within the blood vessel.
  • the portion of the first end of the second lumen which extends beyond the first end of the first lumen should be reinforced to prevent the first end of said second lumen from buckling during insertion of the multiple lumen catheter into the blood vessel.
  • Placement of the catheter can be facilitated if the first and second lumens of the catheter are secured to each other, although the attachment of the first and second lumens to each other is not essential in order to practice the present invention.
  • the tubular wall that forms the first lumen is preferably extruded from a thermoplastic material, and the portion of such tubular wall that adjoins the second lumen can be extruded beyond the first end of the first lumen to extend to the first end of the second lumen to provide the desired reinforcement to the first end of the second lumen.
  • the method further includes the step of forming the first end of the second lumen to be sufficiently pliable to collapse and flatten in the absence of any positive fluid pressure applied to the second end of the second lumen, while allowing the first end of the second lumen to expand and assume a generally-cylindrical shape upon the application of a positive fluid pressure to the second end of the second lumen, as when introducing fluid into the blood vessel.
  • the second end of the second lumen is formed to be sufficiently rigid to maintain a generally-cylindrical shape in the absence of any positive fluid pressure applied thereto.
  • the first ends of the first and second lumens are inserted through the patient's skin and into a blood vessel, while leaving the second ends of the first and second lumens outside the patient's body in order to access the first and second lumens externally.
  • the method includes the step of forming a transition region within the second lumen separating the collapsible first end of the second lumen from the remaining non-collapsible portion of the second lumen; the first ends of the first and second lumens are inserted sufficiently far into the blood vessel to include the transition region of the second lumen within the blood vessel.
  • One aspect of the above-described method is to perform hemodialysis by coupling the second end of the first lumen to an aspiration port of a hemodialysis machine to withdraw blood containing toxins from the blood vessel, and coupling the second end of the second lumen to a cleaned blood return port of the hemodialysis machine for returning cleaned blood to the blood vessel.
  • the first end of the second lumen is preferably extended beyond the first end of the first lumen for introducing clean blood into the blood vessel through the second lumen at a point spaced apart from the first end of the first lumen.
  • the method may include the step of securing a portion of the outer periphery of the first lumen to an adjoining portion of the outer periphery of the second lumen.
  • the step of providing the first lumen can advantageously include the step of extruding generally-cylindrical walls that form the first lumen; in this event, the extruding step may advantageously include the step of extruding a portion of the wall of the first lumen that is secured to the second lumen beyond the first end of the first lumen to the first end of the second lumen to reinforce the first end of the second lumen and thereby prevent the first end of the second lumen from buckling during insertion into the blood vessel.
  • the method may also include the step of placing an introducer sheath, preferably of the peel-away type, through the patient's skin and into the patient's blood vessel, and thereafter inserting the first ends of the first and second lumens through the introducer sheath.
  • the introducer sheath may then be peeled away, leaving the catheter in place within the blood vessel.
  • the method may include placing a guide wire through the patient's skin and into the patient's blood vessel, and thereafter inserting the first end of the second lumen over the guide wire and advancing the first ends of the first and second lumens through the patient's skin and into the blood vessel.
  • This method may also include the further step of tapering the first end of the first lumen to reduce the likelihood of trauma to the blood vessel when the second lumen is advanced over the guide wire.
  • a multiple lumen catheter constructed in accordance with one preferred embodiment of the present invention is shown in Figs. 1-4 and is identified generally by reference numeral 10.
  • catheter 10 is designed to be placed into a blood vessel of a patient.
  • Catheter 10 includes a first flexible tubular lumen 12 which, as shown best in Figs. 2, 3 A and 3B, has a generally-cylindrical shape.
  • first flexible tubular lumen 12 which, as shown best in Figs. 2, 3 A and 3B, has a generally-cylindrical shape.
  • First lumen 12 is preferably formed of a thermoplastic material that can be extruded.
  • first lumen 12 extends between a first distal end 14 and an opposing second proximal end 16.
  • first end 14 of first lumen 12 is adapted to extend within a blood vessel 44 of a patient, while second end 16 of first lumen 12 is adapted to remain outside the patient's body for exchanging fluids with blood vessel 44.
  • first lumen 12 is formed by a tubular wall that has a relatively constant thickness along its length.
  • First lumen 12 is sufficiently rigid to maintain its generally-cylindrical shape under normal usage, including those instances when a negative pressure is applied to second end 16 of first lumen 12, as when aspirating blood from blood vessel 44.
  • first lumen 12 is sufficiently flexible to avoid discomfort or trauma to the patient.
  • Catheter 10 also includes a second flexible tubular lumen 18 extending generally parallel to first flexible lumen 12. As shown in Figs. 1-4, second lumen 18 is secured alongside first lumen 12; however, as indicated by the alternate embodiment illustrated in Fig. 8, the first and second lumens needs not be physically secured to each other along their respective lengths. Within Figs. 1-4, the contact point at which the outer periphery of first lumen 12 is joined to the outer periphery of second lumen 18 is indicated by reference numeral 19. Second lumen 18 may be formed of the same thermoplastic material as first lumen 12, and first lumen 12 and second lumen 18 can be extruded concurrently, if desired.
  • the second end 22 of second lumen 18 is formed by a tubular wall that has a thickness comparable to that of first lumen 12.
  • second end 22 of second lumen 18 is sufficiently rigid to maintain a generally-cylindrical shape even in the absence of any positive fluid pressure applied thereto.
  • the first distal end 20 of second lumen 18 is formed by a tubular wall of much thinner construction.
  • First distal end 20 of second lumen 18 is sufficiently pliable to collapse and flatten in the absence of any positive fluid pressure applied to second end 22 of second lumen 18, as is indicated in Fig. 3B. It its collapsed state shown in Fig.
  • second lumen 18 has a smaller surface area exposed to blood, and catheter 10 occupies a smaller cross-sectional area within the blood vessel.
  • first distal end 20 of second lumen 18 is also sufficiently pliable to expand and assume a generally-cylindrical shape upon the application of a positive fluid pressure to second end 22 of second lumen 18, as when introducing blood or another fluid into blood vessel 44.
  • first end 20 of second lumen 18 is formed of a collapsible, but relatively inelastic, material; accordingly, when first end 20 is infusing fluid into blood vessel 44, first end 20 expands to a generally-cylindrical shape of a fixed diameter.
  • the term "pliable", as used herein, should not be construed as being limited to inelastic materials.
  • reference numeral 21 indicates the transition point at which second lumen 18 transitions from a semi-rigid non-collapsible tubular structure to a yielding and collapsible tubular structure.
  • transition point 21 separates the collapsible first end 20 of second lumen 18 from the remaining non-collapsible portion of second lumen 18.
  • catheter 10 is inserted sufficiently far into blood vessel 44 to assure that transition point 21 lies within the blood vessel. In this manner, one may assure that the catheter tract 46 formed through the skin 42 and blood vessel 44 does not significantly change in size when collapsible end 20 of second lumen 18 is expanded by infused fluid. Therefore, the risk of skin tearing, bleeding and/or infection is minimized while maintaining the benefit of a collapsible lumen within the blood vessel.
  • first and second lumens 12 and 18 are preferably secured to a Y-hub, or connector hub, 24. Extending from such connector hub are a first connector tube 26 and a second connector tube 28. Connector hub 24 couples first connector tube 26 to second end 16 of first lumen 12 for communicating therewith, while coupling second connector tube 28 to the second end 22 of second lumen 18 for communicating therewith. As shown in Fig. 1, a suture wing 30 may be rotatably secured to connector hub 24 for allowing the connector hub to be sutured to the patient's skin adjacent the puncture site 46 (see Fig. 4).
  • a pair of clamps 32 and 34 may be secured over connector tubes 26 and 28, respectively, for selectively closing off such connector tubes before and after each hemodialysis procedure.
  • a pair of luer lock connector fittings 36 and 38 are secured to the free ends of connector tubes 26 and 28, respectively, for conveniently allowing catheter 10 to be interconnected with fluid infusion lines, aspiration lines, or with the blood inlet and blood return ports of a hemodialysis machine.
  • first distal end 20 of second lumen 18 is thinner than the second end 22 thereof
  • first distal end 20 is more pliable and collapsible as compared with second end 22.
  • transition point 21 may represent a junction point at which a first tube made of a first pliable material, and extending from transition point 21 to the distal end of lumen 18, is joined to a second tube made of a second flexible, but non-collapsible, material extending from transition point 21 to connector hub 24.
  • dual lumen catheter 50 includes a first flexible, but non-collapsible, lumen 52 and a second flexible lumen 54 extending generally parallel to lumen 52 and secured thereto along its length.
  • First lumen 52 has a generally-cylindrical shape and extends between opposing first and second ends 56 and 58, respectively. As indicated in Figs.
  • Second flexible lumen 54 extends between opposing first and second ends 60 and 62, respectively.
  • First end 60 of second lumen 54 is adapted to extend within blood vessel 44 generally proximate first end 56 of first lumen 52, while second end 62 of second lumen 54 is adapted to remain outside the patient's body for exchanging fluids with blood vessel 44.
  • first end 60 of second lumen 54 is sufficiently pliable to collapse and flatten against first lumen 52 in the absence of any positive fluid pressure applied to second end 62 of second lumen 54, as illustrated in Figs.
  • first end 60 of second lumen 54 is sufficiently pliable to expand and assume a generally cylindrical shape upon the application of a positive fluid pressure to second end 62 of second lumen 54 when introducing fluid into blood vessel 44, as shown in Fig. 5.
  • second lumen 54 includes a transition region, designated by reference numeral 64 in Figs. 5-7, which separates the collapsible first end 60 of second lumen 54 from the remaining non-collapsible portion thereof. As further indicated in Figs. 5-7, this transition region 64 is adapted to extend within blood vessel 44, such that the non-collapsible portion of second lumen 54 extends through the puncture site 46 of the patient's skin 42.
  • a peel-away type introducer sheath 66 is shown to facilitate the placement of catheter 50 into blood vessel 44.
  • introducer sheath 66 is inserted through the patient's skin 42 at catheter tract 46 and into the patient's blood vessel 44, in a manner well known to those skilled in the art.
  • first ends 56 and 60 of catheter 50 are inserted into the proximal end of introducer sheath 66, and catheter 50 is then advanced through introducer sheath 66 sufficiently far to ensure that transition region 64 lies within blood vessel 44. Introducer sheath 66 is then pulled apart and peeled away, leaving catheter 50 in place.
  • first end 60 of second lumen 54 should remain sufficiently collapsible to substantially flatten between infusion procedures.
  • first lumen 52 is formed by an extruded tubular wall
  • desired reinforcement for first end 60 of second lumen 54 can be provided by simply continuing the extrusion of a portion of such tubular wall beyond first end 56 of first lumen 52.
  • an arcuate segment 68 of the tubular wall forming first lumen 52 extends beyond first end 56 thereof until reaching first end 60 of second lumen 54.
  • This arcuate segment corresponds to the portion of first lumen 52 that adjoins, and is secured to, the outer periphery of second lumen 54.
  • Figs. 5 an arcuate segment 68 of the tubular wall forming first lumen 52 extends beyond first end 56 thereof until reaching first end 60 of second lumen 54.
  • This arcuate segment corresponds to the portion of first lumen 52 that adjoins, and is secured to, the outer periphery of second lumen 54.
  • the elongated reinforcing member for preventing the first end 60 of second lumen 54 from buckling could, if desired, be incorporated within an arcuate portion of the tubular wall forming first end 60 itself.
  • an arcuate (e.g., 40°) of the tubular wall of first end 60 could be more rigid than the remaining arcuate portions (320°) of such tubular wall for allowing first end 60 to substantially flatten and collapse when no fluid is being infused, while nonetheless preventing first end 60 from buckling during placement into the blood vessel through an introducer sheath.
  • this third embodiment may not form as compact a structure, when infusion is stopped, as compared with catheter 10 of Fig. 4 or catheter 50 of Fig. 7, the collapsible portion of second lumen 18' nonetheless will collapse against either first lumen 12', or against the walls of blood vessel 44', thereby reducing the overall dimensions of the catheter when not in use.
  • the descriptions of the preferred embodiments of the present invention set forth above also demonstrate that the catheter of the present invention is useful in a method of exchanging fluids with a blood vessel of a patient.
  • This method includes the step of providing a first flexible lumen, such as lumen 12, having a generally- cylindrical shape and having opposing first and second ends 14 and 16.
  • the preferred method also includes the step of ensuring that the first lumen 12 is sufficiently rigid to maintain its generally-cylindrical shape when negative pressure is applied to the second end 16 thereof.
  • the method also includes the step of providing a second flexible lumen, such as lumen 18, having opposing first and second ends 20 and 22, and extending generally parallel to first flexible lumen 12.
  • a second flexible lumen such as lumen 18, having opposing first and second ends 20 and 22, and extending generally parallel to first flexible lumen 12.
  • the first end 20 of the second lumen 18 is formed to be sufficiently pliable to collapse and flatten in the absence of any positive fluid pressure applied to the second end 22 of the second lumen 18; on the other hand, first end 20 is formed to be sufficiently pliable to expand and assume a generally-cylindrical shape upon the application of a positive fluid pressure to second end 22 of second lumen 18 when introducing fluid into the blood vessel.
  • the method includes the step of forming second end 22 of second lumen 18 to be sufficiently rigid and non-collapsible to maintain a generally cylindrical shape even in the absence of any pressurized fluid applied to second lumen 18.
  • the method of exchanging fluids with a blood vessel of a patient further includes the step of inserting the first ends 14 and 20 of the first and second lumens 12 and 18, respectively, through the patient's skin 42 and into the blood vessel 44, while leaving the second ends 16 and 22 of the first and second lumens 12 and 18, respectively, outside the patient's body in order to access the first and second lumens externally.
  • a transition region 21 is created therein which separates the collapsible first end 20 of second lumen 18 from the remaining non-collapsible portion thereof.
  • the method also includes the step of inserting the first ends 14 and 20 of first and second lumens 12 and 18 sufficiently far into the blood vessel 44 to include the transition region 21 of second lumen 18 within blood vessel 44.
  • an improved multiple lumen catheter which reduces the likelihood of formation of clots within a blood vessel into which the catheter is placed by allowing at least one of such lumens to collapse between infusion procedures.
  • the ability of such lumen to collapse within the blood vessel decreases its cross-sectional dimensions within the blood vessel when the catheter is not being used for infusion or dialysis, but without compromising the size of the flow path when the collapsible lumen is expanded to infuse fluids.
  • Such decrease in cross-section dimension causes less turbulence and slowing of blood which minimizes the likelihood of vessel thrombosis.

Abstract

Ce cathéter à plusieurs lumières (10) comprend une première lumière souple et généralement cylindrique (12), laquelle s'étend entre une première extrémité distale (14) et une seconde extrémité proximale (16), est suffisamment rigide pour conserver sa forme généralement cylindrique lorsque l'on applique une pression négative sur cette lumière, aux fins d'aspiration de fluide à partir d'un vaisseau sanguin, ainsi qu'une seconde lumière souple (18) s'étendant, le long de la première lumière, également entre une première extrémité distale (20) et une seconde extrémité proximale (22). La première extrémité distale de la seconde lumière est suffisamment souple pour pouvoir s'affaisser et s'aplatir en l'absence d'une quelconque pression fluidique positive appliquée sur la seconde lumière, mais lors de l'application d'une telle pression, elle se dilate et prend une forme généralement cylindrique permettant l'introduction de fluide dans le vaisseau sanguin, et elle peut, d'ailleurs s'étendre au-delà de la première extrémité non souple de la première lumière, aux fins d'introduction de fluide dans le vaisseau sanguin à travers cette seconde lumière, au niveau d'un point espacé et séparé de la première extrémité de la première lumière. Dans des applications du type hémodialyse, on utilise la première lumière pour aspirer le sang et la seconde pour renvoyer le sang épuré.

Claims (10)

  1. Cathéter (10) à plusieurs lumières pour placement dans un vaisseau sanguin d'un patient, comprenant en association :
    a. un premier tube flexible (12) ayant une forme généralement cylindrique et ayant des première et seconde extrémités (14, 16) opposées, la première extrémité (14) du dit premier tube étant adaptée pour s'étendre dans le vaisseau sanguin (44) du patient, la seconde extrémité (16) du dit premier tube étant adaptée pour rester à l'extérieur du corps du patient pour échanger des fluides avec le vaisseau sanguin du patient, ledit premier tube étant suffisamment rigide pour conserver sa forme généralement cylindrique lorsqu'une pression négative est appliquée sur la seconde extrémité du dit premier tube pour aspirer le fluide se trouvant dans le vaisseau sanguin, ledit premier tube définissant une première lumière ;
    b. un second tube flexible (18) s'étendant généralement parallèlement au dit premier tube flexible, ledit second tube ayant des première et seconde extrémités (20, 22) opposées, la première extrémité (20) du dit second tube étant adaptée pour s'étendre dans le vaisseau sanguin (44) du patient généralement à proximité de la première extrémité (14) du dit premier tube, la seconde extrémité (22) du dit second tube étant adaptée pour rester à l'extérieur du corps du patient pour échanger des fluides avec le vaisseau sanguin du patient, ledit second tube définissant une seconde lumière ;
    c. la seconde extrémité (22) du dit second tube étant suffisamment rigide et non pliable pour maintenir une forme généralement cylindrique en l'absence de toute pression de fluide positive appliquée à la seconde extrémité du dit second tube ; et
    d. ledit second tube (18) incluant une région (21) de transition séparant ladite première extrémité pliable du dit second tube de la partie non pliable restante du dit second tube, dans lequel ladite région de transition est adaptée pour s'étendre dans le vaisseau sanguin du patient, caractérisé en ce que :
    e. la première extrémité (20) du dit second tube étant suffisamment souple pour se plier et s'aplatir en l'absence de toute pression de fluide positive appliquée à la seconde extrémité du dit second tube, et suffisamment souple pour s'étendre et prendre une forme généralement cylindrique lors de l'application d'une pression de fluide positive à la seconde extrémité du dit second tube lors de l'introduction de fluide dans le vaisseau sanguin.
  2. Cathéter à plusieurs lumières selon la revendication 1 dans lequel la première extrémité (20) du dit second tube s'étend au-delà de la première extrémité (14) du dit premier tube pour introduire du fluide dans le vaisseau sanguin (44) à travers ledit second tube en un point écarté de la première extrémité du dit premier tube.
  3. Cathéter à plusieurs lumières selon la revendication 1 dans lequel la seconde extrémité (16) du dit premier tube est adaptée pour être couplée à un orifice d'aspiration d'une machine d'hémodialyse pour prélever le sang contenant des toxines dans le vaisseau sanguin (44) et dans lequel la seconde extrémité (22) du dit second tube est adaptée pour être couplée à un orifice de retour du sang purifié de la machine d'hémodialyse pour renvoyer le sang purifié au vaisseau sanguin, le cathéter pouvant être utilisé pour réaliser l'hémodialyse.
  4. Cathéter à plusieurs lumières selon la revendication 1 incluant un premier et un second tubes (26, 28) de connecteur et incluant en outre un collet (24) de raccord, le collet de raccord étant fixé aux secondes extrémités (16, 22) desdits premier et second tubes, le collet de raccord couplant la seconde extrémité du dit premier tube au dit premier tube de connecteur, et le collet de raccord couplant la seconde extrémité du dit second tube au dit second tube de connecteur.
  5. Cathéter à plusieurs lumières selon la revendication 2 dans lequel ledit premier tube flexible est fixé sur sa longueur au dit second tube flexible.
  6. Cathéter à plusieurs lumières selon la revendication 5 dans lequel ledit premier tube (52) inclut une paroi tubulaire extrudée fixée au dit second tube et dans lequel une partie de ladite paroi tubulaire extrudée du dit premier tube est extrudée au delà de la première extrémité (56) du dit premier tube à la première extrémité (60) du dit second tube (54) pour empêcher la première extrémité du dit second tube de s'enrouler lors de l'insertion du cathéter à plusieurs lumières dans le vaisseau sanguin (44).
  7. Cathéter à plusieurs lumières selon la revendication 6 incluant en outre une gaine d'introducteur (66) traversant la peau (42) du patient et pénétrant dans le vaisseau sanguin (44) du patient, lesdits premier et second tubes s'étendant dans et traversant ladite gaine d'introducteur.
  8. Cathéter à plusieurs lumières selon la revendication 1 dans lequel la première extrémité du dit second tube inclut un membre de renforcement allongé (68) pour empêcher la première extrémité (60) du dit second tube de s'enrouler pendant l'insertion du cathéter à plusieurs lumières dans le vaisseau sanguin (44).
  9. Cathéter à plusieurs lumières selon la revendication 1 incluant un fil de guidage (40) traversant ladite seconde lumière (18) pour insérer le cathéter à plusieurs lumières dans le vaisseau sanguin (44) à travers la peau du patient.
  10. Cathéter à plusieurs lumières selon la revendication 9 dans lequel la première extrémité (14) du dit premier tube est conique pour réduire le risque de lésion du vaisseau sanguin lorsque ladite seconde lumière (18) est guidée sur le fil de guidage (40).
EP97948217A 1996-11-29 1997-11-26 Catheter de dialyse presentant des lumieres rigides et souples Expired - Lifetime EP0961628B1 (fr)

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Application Number Priority Date Filing Date Title
US758382 1996-11-29
US08/758,382 US5807311A (en) 1996-11-29 1996-11-29 Dialysis catheter having rigid and collapsible lumens and related method
PCT/US1997/020455 WO1998023319A1 (fr) 1996-11-29 1997-11-26 Catheter de dialyse presentant des lumieres rigides et souples et procede associe

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EP0961628A1 EP0961628A1 (fr) 1999-12-08
EP0961628A4 EP0961628A4 (fr) 2000-05-10
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CA2272336A1 (fr) 1998-06-04
CA2272336C (fr) 2007-04-10
DE69731979T2 (de) 2005-12-01
EP0961628A1 (fr) 1999-12-08
US5807311A (en) 1998-09-15
DE69731979D1 (de) 2005-01-20
WO1998023319A1 (fr) 1998-06-04
EP0961628A4 (fr) 2000-05-10

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